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									   Healthy Food and Nutrition
   During the Cancer Journey
Native Families Cancer Caregiver Workshop
              May 28-30, 2008
• Objective
  – Describe the basics of nutrition intervention
    during cancer treatment, and nutrition for
    cancer prevention.
“Before we can start talking about nutrition,
  we have to renew the spiritual connection
  our people had with food as a gift from the
  Creator. It makes sense for us to renew
  our bodies with that traditional source”
    -- L. DeCora, RN, Winnebago Tribe (as quoted in
  LaDuke, 2005, p. 20)
Images of Wellness
Slow foods - absorption keeps pace with
          insulin production
Original American Foods
Three out of every 4 plants we eat today
 were first grown by Native Americans.

   Tomato                 Coffee
   Beans                  Tobacco
   Peanuts                Cocoa
   Sunflowers             Cranberry
   Avocado                Pumpkin
   Squash                 Pineapple
Food System Change
Our Changing Diet Composition

Hunter/Gatherer Diet               Early Reservation Era      Modern Diet

 20%                                                                  15%
                     Protein                28%   25%
       40%                                                    37%
 40%                 Fat
                                              47%                    48%

              Source: Yvonne Jackson,
              1994, Diabetes: A Disease                    Source: The Strong
               of Civilization. Mouton de                  Heart Study, 1993
                         Gruyter.                          Welty, Zephier.
Current Diets of Native Americans
Since the 1960’s most Native               Pro
 American’s had diets similar    Fat

 in composition (pro/carb/fat)   35-40%
 to that of the non-Indian             45-50%

 population, intakes have
 been shown to be similar as
                                  Source: The Strong
                                  Heart Study, 1993
                                    Welty, Zephier.
           Current Diets      (continued)

 About 65% of Native
  American’s living on        Nutrient Mix: Commodity Food
  reservations receive
  either food commodities          28%

  or food stamps.
 Intermittent                             58%

  Food Insecurity
                              Protein    Carbos    Fat
  exists in 9% of families.
       Introduced Food System
             Obesity Promoting Environment

   Highly refined packaged foods
   White and other refined flours
   High fructose corn syrup
   Saturated and trans fats
   High sodium/salt
   Deep fried
   Sugared/artificially sweetened drinks
   Sedentary lifestyle
              Food Sovereignty
• “Food Sovereignty”
    – Rights of peoples to define how they will hunt, grow,
      gather, sell, or give food with respect to their culture
      and management of natural resources (International
      Indian Treaty Council, 2002)
• Native people’s loss of land and resources has impacted
  “food sovereignty”
• Food assistance programs and a “westernization” of
  lifestyles have impacted Native American health and
Many Native people consider the restoration of
traditional subsistence foods and practices as
essential in order to regain their health,
traditional economy and culture for generations
to come.
    Tribal Food System Initiatives
 Gardening Projects lead by Tribal Colleges
 Buffalo Herds: both tribal and private
 Traditional harvesting and gathering of foods.
Native American Natural Foods
  Based in Kyle, SD on the Pine Ridge Reservation

Made from all-natural buffalo and cranberries, two
 indigenous foods from Native America.
           Comparison of Meats
             (3.5 oz Portion)
       Hot Dog            Ground Buffalo
   Fat - 25 grams        Fat - 2.4 grams
   Protein - 12 grams    Protein - 28.4 grams
   Saturated Fat – 10    Saturated Fat – 1 gr.
    g                     Contains Essential
   Contain                          Fatty Acids
Current Food Guide Pyramid….
                          Key Messages:
                          •Focus on Fruits
                          •Vary your veggies
                          •Get your calcium-rich
                          •Make half your grains
                          •Go lean with protein
                          •Know the limits on fats,
                          salt, and sugars

        Personalizable at: MyPyramid.gov
          Cancer Prevention
  American Cancer Society Guidelines on
               Diet and Nutrition
• Choose most of the foods you eat from
  plant sources.
• Eat five or more servings of fruits and
  vegetables each day.
• Eat grains and starchy vegetables: corn
     breads, cereals, rice, pasta, & beans.
            Cancer Prevention
    American Cancer Society Guidelines on
                 Diet and Nutrition
•   Limit your intake of red meats.
•   Choose low-fat dairy products.
•   Use foods and beverages low in sugar.
•   Limit alcoholic beverages if you drink at
          Cancer Prevention
  American Cancer Society Guidelines on
              Diet and Nutrition
• Be physically active – achieve and maintain
  a healthy weight.
• Be at least moderately active for 30
  minutes or more on most days of the week.
• Stay within your healthy weight range.
Source: http://www.tribalconnections.org/health_news/native_roots/april2004p1.html
Kibbe Conti, Registered Dietician, Northern Plains Nutrition Consulting
Nutrition during
Cancer Treatment
          Nutrition intervention
            in Cancer Care:
• Good nutrition is important during cancer
  treatment because it:
  – Keeps up the body’s ability to fight infection
  – Preserves and rebuilds body tissues
  – Improves strength and energy
     Nutrition in Cancer Care
• Goals:
  – Prevent weight loss even in overweight
  – Maintain lean muscle mass/protein reserves.
  – Nutrition therapy to improve management of
    some symptoms and improve quality of life.
        Nutrition Support with
        Enteral Tube feedings
• Malnourished patient undergoing surgery
• Management of the critically ill patient
• Patients undergoing bone marrow
• Patients treated for pancreatic cancer
• Patients with head and neck cancer
              Tips About Fluids
• Take small sips often
• Do not drink too much at once
• Keep a small glass of water or juice at bedside or next to
• Use a straw for small sips
• Use ice chips to relieve dry mouth
      Involuntary Weight Loss
• Many individuals going through cancer treatment
  lose weight
• Try increasing calories and protein by using
  certain foods/ingredients to prepare foods:
  – Add 1-2 tsp. butter, to hot cereal. Add cream to
    soups, sauces.
  – Add eggs to salads, casseroles, etc.
  – Use more cheese on sandwiches, in soups, with rice
    and noodles, etc.
  – Make a fruit smoothie with fruit, juice, ice and protein
     General Caregiver Nutrition Tips
• Help your loved one make the most of the good days
   – Keep ready-to-serve and easy-to-prepare foods available:
     peanut butter, pudding, tuna, protein bars, trail mix, cheese and
     crax and boiled eggs.
   – Serve small portions, large portions might overwhelm patient.
• If getting enough calories and protein from food
  becomes a problem, you may need to try liquid meal
  replacements (e.g., Ensure, protein bars)
           – Don’t try to force person to eat
   Taste and Smell Alterations
  Changes in the usual patterns of taste perception

• Decreased taste sensitivity
• Absence of taste sensation
• Distortion of normal taste
     Common Taste Alterations
• Decreased taste threshold for bitter foods
• Aversion to foods with high amino acids: chocolate,
  coffee, red meats.
• Increased threshold for sweet foods:      need increased
  sugar to taste sweetness
• Metallic or medicinal taste may be sensed continuously
  even when not eating
• Decreased threshold for salty foods
 Suggestions for Altered Taste
• If foods too sweet, addition of lemon or sour
  sauces or salt may decrease sweetness.
• Serve more poultry, fish/shellfish and eggs.
• Marinating meats in fruit juice or commercial
  marinade may disguise bitter taste.
• Plastic utensils may be used if metallic taste
         Nausea & Vomiting
• Eat multiple small meals or snacks instead
  of 3 large ones.
• Eat dry foods upon wakening and
  throughout the day: crackers, dry toast.
• Avoid foods with strong odors.
• Avoids foods that are overly spicy, fried, or
         Nausea & Vomiting
• Avoid being in the area where food is
• Drink adequate fluid with an additional ½
  cup to 1 cup liquid for each episode of
• Take antiemetic (anti-nausea) meds as
    Low White Blood Cell Count
         Food safety guidelines
• Discard leftovers stored at room temp. for
  more than 2 hours.
• Discard leftovers older than 2 days.
• Do not drink directly from cans. Wash can
  before opening and use a cup.
• Thaw frozen foods in the refrigerator or in
  cold water.
     Low White Blood Cell Count
          Food safety guidelines
• Cook meats thoroughly (165 F).
• Wash hands before food preparation.
• Use separate cutting boards for produce
  and meat.
• Don’t eat raw vegetables, fruits.
  – Banana, juices, melon and canned fruits okay.
    Diarrhea Nutrition Therapy
• Limits caffeine, fat and concentrated
• Choose foods with less than 2 grams fiber
• No raw vegetables, no broccoli, cabbage...
• No raw fruits except banana and melons.
• Offer rehydration beverages, water and or
  caffeine free teas.
Nutrition for Cancer Survivors
 Nutrition After Cancer Treatment
• Return to healthy weight
  – Right after treatment ends, cancer survivors
    should plan their nutrition so that their weight
    returns to a healthy, normal level.
  – Exercise is important in restoring lean muscle
   Nutrition for Long-Term Cancer
• After the body has returned to a healthy balance,
  follow nutrition recommendations for a healthy
  –   Keep weight within normal limits
  –   Limit high fat foods
  –   Eat plenty of fruits and vegetables
  –   Choose fresh, lean meats
  –   Exercise
  –   Follow instructions for any special diets (example:
      diabetic diets, low salt diets)
     The Caregiver’s Nutrition
• Caregivers may gain or lose weight while their
  loved one goes through cancer treatment or
  during end-of-life care.
• Caregivers may not feel like eating.
• They may not have time to prepare their own
• Caregiver supporters should help caregiver
  meet their own nutrition needs.
     Questions for Discussion
• How can a community help caregivers
  maintain their own healthy nutrition while a
  loved one is getting treated for cancer?

• How can a community help caregivers with
  nutrition during end-of-life care?

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